URTI + PNA ** Flashcards
Sinusitis vs rhinosinusitis
Sinusitis: inflammation of 1 or more paranasal sinuses
Rhinosinusitis: inflammation of nasal mucosa + sinuses
RF for sinusitis
CF, immunodeficiency, irritants, deviated septum, polyps, cocaine use, trauma
Acute vs chronic vs ped causes of sinusitis
Acute causes: s pneumonia, H influenza
Chronic causes: S aureus, pseudomonas, enterobacteriaceae
Child causes: moraxella catarrhalis
Sx + complications of sinusitis
Sx: persistent URTI sx, no improvement in 10d
PODS: facial PAIN, nasal OBSTRUCTION, nasal DISCHARGE, SMELL disorder
Complications: periorbital cellulitis, meningitis, intracranial abscess, sepsis
Preseptal Cellulitis
Postseptal Cellulitis
Abscess (Sinus, Orbital, Subperiosteal, Brain)
Meningitis
Cavernous Sinus Thrombosis
Osteomyelitis
Rx for:
Acute mild/ mod
Severe
Chronic w/o nasal polyps
Chronic w/ nasal polyps
Acute mild/ mod: intranasal steroids, abx if no improvement
Severe: intranasal steroid + amoxicillin
Chronic w/o nasal polyps: intranasal steroids
Chronic w/ nasal polyps: intranasal steroids + oral steroids + amox/clav x3w
Sx + complications of EBV
Complications: airway obstruction with large tonsils, encephalitis, myocarditis, splenic rupture, lymphoma
Sx: fatigue, sore throat, fever, nausea, anorexia, cough, photophobia, lymphadenopathy
Ix + Rx EBV
Ix: EBV serology, ESR
Rx: consider steroids if impending airway obstruction, off sports x3w
Sx of EBV
Sx: erythema, edema of pharynx, tonsillar exudate, lymphadenopathy, scarlet fever (sandpaper rash), strawberry tongue
FeverPAIN criteria
FeverPAIN criteria: temp >38, tonsillar exudate, severely inflamed tonsils, absence of cough
2-3 = FU or delayed script
4 = abx
Ix, rx + when to refer for surgery for pharyngitis
Ix: throat culture or rapid antigen test
Rx: Pen V 300mg TID or amoxicillin 500mg BID
Refer for tonsillectomy: >7/yr, >5 in 2yr, >3 in 3yr
How to manage high risk groups
Flu + pneumococcal vaccine
Treat early with oseltamivir phosphate, amantadine
qSOFA score
RR >22, altered MS, systolic BP <100
DDx for PNA
PJP, TB, Mycobacterium avium complex, influenza, toxoplasmosis
What abx partially treat TB?
Fluoroquinolones
Dx of PJP
bronchoscopy
Factors affecting abx choice
interaction (warfarin), allergy, COPD co-treatment, what bugs cover (ie aspiration)
PNA bugs in pts w/ no comorbidities
mycoplasma + chlamydophilia
PNA bugs in pts w/ comorbidities
staph aureus, h. Influenza, moraxella catarrhalis
Kids PNA rx
amox, FU exam
PSI score components
PNA severity index:
age, sex, nursing home resident, neoplastic dz, liver dz, CHF, CVD, renal dz, altered MS, RR >30, systolic BP <90, temp <35 or >39.9, pulse >135, pH <7.35, BUN >11, Na <130, glucose >14, hematocrit <30, ppO2 <60, pleural effusions on XR
Common cold prevention
zinc sulphate, hand washing
Common cold treatment
NSAIDs, antihistamine, intranasal ipratropium, honey (if >12mo)
Otrovent use in rhinomedicomosa can cause what serious SE?
thunderclap headache secondary to vasoconstriction
Sinusitis sx
PODS (pain/ pressure, obstruction, discharge, lack of smell)
Sinusitis ALARM features
persistent fever >39, periorbital edema, cranial nerve palsies, abnormal extraocular movements, proptosis, vision changes, severe HA, altered MS, meningeal signs
Sinusitis dx + rx
dx clinically, start w/ amox for 5-10 days, nasal rinse in shower, IN steroids, decongestants, analgesics, anti-inflammatories
FEVERPAIN components
fever in last 24hrs, purulent tonsils, no cough, tonsil inflammation, <3 days onset
Mono sx + how it is spread
spread by saliva, sx: lymphadenopathy, fever, pharyngitis, malaise, fatigue, HA
Mono labs
lymphocyte count, AST, ALT, monospot
Mono spleen counselling
splenomegaly in 50%, rupture 1 in 1000, no contact sports x3wks, can last up to 8wks
Influenza antivirals
osetlamivir, if high risk start within 12 hrs of sx
